Nursing Care: Restraint Usage, Evidence-Based Practice and Research

Journal Critique/Review

McKinley, C. et al. (2007). Practice: Reducing Falls in Hospital. Collegian, 14 (2), p 20-25.

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Research sections analysis

The authors of the article referenced above touch on several research aspects including background information, literature review, methodology used in the research, data analysis/interpretation and conclusion (McKinley et al., 2007). This is well illustrated by the graphical presentation illustrated below:

Graphical presentation

The diagram elaborates the fundamental aspects addressed by the research paper. The introduction section covers three fundamental areas which include research objectives, scope and justification and further describes the location of research description of the location. In the introductory sentence, the researchers define the topic in a way that enlightens the reader on what the research is all about. The researchers briefly use this section to introduce the reader to the research and build an image of what to expect from the paper. In general, the reader can easily understand the focus of the research based on this section.

Additionally, the researchers clearly articulate the benefits expected in this research and the possible beneficiaries (McKinley et al., 2007). The research problem is well articulated and hence sets the path for review of literature material that would aid in answering the research question. In this section, the research proposes the use of the evidence-based practice as a tool for reducing falls in hospitals and goes further to investigate the same.

In the literature review section, the authors take the reader through a series of previous research articles that bear relation to hospital falls. It is essentially made of three fundamental components in terms of content. These include justification of the problem statement made in the introductory section, description of the steps necessary in the development of best-practice programs and finally, the use of the best practice in the prevention of falls (McKinley et al., 2007).

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In justifying the problem statement, the authors look at literature materials that offer reliable information about hospital falls. More precisely, the literature review section offers reliable statistical information that re-affirms falls in hospitals as a problem worth addressing. However, this is not the focus of the section as the authors swiftly address key research articles that are likely to form part of a weight scale about the current research findings. Various possible strategies for development are evaluated in this section before the author narrows down to evidence-based practice as a possible breakthrough in the reduction of falls in hospitals.

Additionally, the authors evaluate some of the methods that are widely acknowledged as offering best practices regarding hospital falls and related areas. Various methodological approaches used by previous researchers are also discussed and compared against each other. The authors then move on to discuss the methodology chosen for use in this research paper. Though this section touches on most aspects that a good literature review should have, the researchers fail to justify their choice of literature materials used in the section. Additionally, no clear literature search criteria are articulated in the paper. This notwithstanding, the section experiences a high level of perfection, drawing from varied literature sources thus justifying its position as an outstanding literature review section.

The methodology section covers both data collection procedures and data analysis techniques. The authors illustrate to the reader the process that led to the data they obtained and how the data are to be analyzed. The Australian incident monitoring system is cited as the primary collection gadget/tool (McKinley et al., 2007). Generally the tool registered incidences recorded just as would have been manually done by the researchers if they opted to do so within the mentioned period.

The advantage of the system, in this case, is cited as its ability to time-efficiently centralize data from all sections into one single database of raw data for research and reference purposes. Additionally, a review of previous reports is used as a data collection methodology. The falls review committee reports are used in the qualitative assessment of the failures and successes of the initiative in comparison to other methodologies. Graphical representations and quantitative statistical analysis tools are used in the evaluation of the raw data obtained.

In the data analysis section, the raw data and qualitative data obtained are analyzed through critical review, statistical analysis, and graphical presentation as discussed in the previous section. This section forms the basis of justifying the findings of the research. The results obtained from the analysis are compared against the literature review findings earlier discussed. In general, the researcher while concluding, makes reference to the statistical analysis results obtained, the graphical presentations, the qualitative review of existing reports and the literature review to either reinforce or dispute previous research findings (McKinley et al., 2007). This allows the researcher to draw up a conclusion.

In the conclusion section, the researchers briefly describe the whole process that led to the aforementioned results. Further, the researchers come up with a raft of recommendations for future researchers in the same area, the hospital management team, the practicing physicians and other stakeholders.

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Validity of Presented Evidence

The critical analysis of the sections presented above answers the questions as to whether the evidence presented in this research supports the conclusion. The research presents a number of materials that are later used in drawing up conclusions. It is important to note that the conclusion section makes plenty of reference to the results and graphical representations in the research paper and compares the same to the literature review findings. In conclusion, the researchers state that nursing shortages have called for need for measures that would enormously limit degeneration of cases into severity states.

Early identification, diagnosis, and taking appropriate preventive measures are cited as the best possible strategy for the reduction of falls in hospitals (Garrard, 2007). Generally, the research paper experiences an outstanding level of sufficiency. Its sections, transit from one to another in a flowing manner such that the conclusion is easily derived from the findings, the findings are easily derived from data analysis and the data analysis is well defined in the methodology section. The author’s conclusion that evidence-based practice can be effectively used in the reduction of falls, is not only confirmed by the analyzed raw data but also reinforced by earlier discussed literature materials.

Generally, the conclusion is not only supported by the findings of the research but also the reviewed literature material and the review of Falls Review Committee. It may be therefore concluded that the final conclusions of this research are enormously supported by the evidence presented in the research where in this case, the evidence includes a review of literature materials used, data analysis results/findings, and review of the Falls Review Committee report. All these points towards the assertions made in the conclusion section of the report.

Ethical Issues

Like any other research paper, several ethical issues arise in this research. These ethical issues in medical practice are aimed at protecting the participant’s rights (Houser, 2008). While voluntary participation is often a necessity in medical research, in this case, the information collected did not have any direct impact on the patient’s rights. This is because no personal information is necessary for the research but rather only data.

However given that only a section of patients was to form the participating sample, their informed consent had to be sought by making them aware that they were party to a research-only those who willingly accepted to be part of the research were included. Additionally, all necessary measures had to be put in place to ensure that the researcher’s health both physical and emotional is not subject to any form of harm during the research. Confidentiality and anonymity, however, topped the agendum of ethical considerations in the research (Brown, 2009).

No personal information that would identify the patient was collected in the research and when such are available, the researchers were obligated not to use it for any purpose other than for the goal of the research. The issue of rights to service may also arise especially when the control group results show positive results compared to the group that was not subjected to the control (Saarnio et al., 2009). The no-control group may feel that their right to service was not adequately guaranteed.

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Likewise, anonymity may be difficult in instances where the patients have to be subjected to continuous tests in the measurement of the effect of the measure being investigated Park & Tang, 2007). Generally, like any other medical research, various ethical measures had to be observed ranging from right to service, anonymity, informed consent, voluntary participation, and confidentiality.

The research approach used/alternative research approaches

The research utilized both qualitative and quantitative research approach in developing its findings. The qualitative approach involved reviews of existing literature and more specifically the findings of the Falls Review Committee. However, this was specifically for secondary research purposes. The Falls Review Committee had overtaken been charged with the responsibility of reviewing the number of falls and causes and appropriately making recommendations with regard to the same. The prime focus of the research methodology is in quantitative analysis which used raw data in generating findings and hence conclusions.

It is important to note that, usually, quantitative methods offer empirical evidence that supports the findings and conclusions of any given research (Meyer et al., 2009). Graphical charts and statistical analysis offer proof of the results obtained in a given research paper. In this case, they adequately allowed comparison of pre and post initiative application and hence draw conclusions with regard to the differences arising between the two circumstances. However, it is a vital note that other methods exist which can be adequately used to research the aforementioned issue. For instance cases study review.

Case study review would involve drawing on several cases which have utilized the above-mentioned criteria in comparison to those that have not utilized the initiative (Cotter & Evans, 2008). This would allow the researcher to identify the possible benefits and dis-benefits associated with the methodology. Another possible methodology for this research would involve the use of questionnaires and interview schedules to generate raw data (Hughes, 2008). This would involve the collection of opinions from physicians regarding the applicability, practicability, and success of the initiative. In general, several research methods are available for use by researchers and often it is challenging to identify the best possible methods that suit any given research (Healey et al., 2008).

Literature search to evaluate nursing care or management implications of a therapeutic nursing intervention

Primary sources matrix

Often diagnosis in nursing is a rather challenging problem. Medical practitioners at times have to deal with a wide range of possible ailments and in some instances have put patients on treatment only to realize after some time that the treatment line adopted is a case of misdiagnosis. The matrix attached (Table 1) illustrates researches that have been done for this purpose (Garrard, 2007).

Annotated bibliography

Elaine M. F. & Tracy, A. (2008). Fostering the scholarship of discovery and integration for advanced practice education. Nursing Education Perspectives, 4(3), p 5 -9.

The authors discuss the importance and need of adopting scholarship discovery in Medicare practice and further integration of the same into treatment practices. It’s important to note that the authors are acclaimed having written several other articles in the field of nursing. Their articles offer insightful understanding into the importance of discovery and integration of scholarship into nursing practice.

Wolff, A. M., Taylor, S. A. & McCabe, J. F. (2007). Using checklists and reminders in clinical pathways to improve hospital inpatient care. Medical Journal of Australia, 181(8), p 428 – 431.

The authors present findings that support the efficacy of using checklists and reminders in in-patient care improvement. Generally, they support the importance of evidence-based practice in patient care management.

Glanville, I., Schrim, V., & Wineman, N. (2008). Using evidence-based practice for managing clinical outcomes in advanced practice nursing. Journal of Nursing Care Quality, 15(1), p 1-11.

The authors take the reader through a process of understanding the importance of clinical outcomes in inpatient care. They investigate and re-affirm the success that has been so far achieved in application of evidence-based care in clinical outcome management. This article is useful in understanding the best practices that facilitate positive clinical outcomes.

Shapiro, S. E. (2010). Grading Evidence for Practice: Looking at graded evidence before changing practice. Advanced Emergency Nursing Journal, 32(1), p 59-67.

The author discusses the importance of graded evidence before the change in treatment practice. The authors in essence reinforce the importance of graded evidence in coming up with reasonable decisions within the medical context.

Shapiro, S. E. & Donaldson, N. A. (2008). Evidence-Based Practice for Advanced Practice Emergency Nurses, Part III: Planning, Implementing, and Evaluating an Evidence-Based Small Test of Change. Advanced Emergency Nursing Journal, 30(3):222-232.

Shapiro, has written many research papers on evidence-based practice brings in prowess in this area. She and her co-author take the reader through a process of understanding the importance of advanced practice nurses to adopt evidence-based practices in clinical emergency care management.

Shapiro, S. E. Evidence-Based Practice for Advanced Practice Emergency Nurses: Using evidence as a basis for advanced practice in the ED. Advanced Emergency Nursing Journal, 29(4):331-338.

Shapiro, like in many of her articles stresses the importance of using evidence as to the basis for making important decisions in advanced nursing practice. The article is useful in widening understanding of evidence-based practice in pre-treatment analysis.

Harrison, M.B. et al. (2006). Leg-ulcer care in the community, before and after implementation of an evidence-based service. Canadian Medical Association Journal, 172(11), p 1447-1452.

Harrison, take the reader through research where pre and post-application of evidence-based practice data are obtained and compared against each other. The case where evidence-based practice is applied resents minor positive results as compared to the earlier. The article offers insightful information that facilitates the readers’ understanding of the benefits/successes associated with evidence-based practice.

Shannon, R. J. (2008). A Cost-utility Evaluation of Best Practice Implementation of Leg and Foot Ulcer Care in the Ontario Community. Wound Care Canada, 5 (1), p 53-56.

Treatment costs are often escalated before the right diagnosis is reached. Importance of the right diagnosis can therefore not be ignored. This article describes how effectively evidence-based practice can be used in early and timely diagnosis and hence save lots of costs that would have been incurred.

Delmas, L. (2007). Best practice in the assessment and management of diabetic foot ulcers. Rehabilitation Nursing Journal, 31(6), p 228-34.

Assessment of diabetic-related conditions is often challenging and takes time to diagnose. The authors of this article highlight the importance of evidence-based practice in the early diagnosis of diabetic foot ulcers. The authors generally stress the use of the evidence-based practice as a tool for early diagnosis.

Osburne, R. C. et al. (2006). Improving Hyperglycemia Management in the Intensive Care Unit: Preliminary Report of a Nurse-Driven Quality Improvement Project Using a Redesigned Insulin Infusion Algorithm. The Diabetes Educator, 32(2): 394-403.

The authors highlight the challenges faced in the management of hyperglycemia. Through a series of case studies, the authors propose evidence managers as the best alternative to hyperglycemia management. They offer insightful information about evidence-based practice in patient management.

Sources Review

The articles reviewed stress the importance of diagnosis in the facilitation of nursing care. The researchers highlight the importance of the adoption of techniques that facilitate timely diagnosis and hence early intervention. Additionally, they stress the importance of the adoption of diagnostic approaches that facilitate the quick well-being of patients and aid the ailment management process. Cost implications are also cited as being dependant on the diagnosis of the right condition promptly and duration.

Effect of tolls used on results of the research

Often the tools used in research determine its validity and hence affect the outcome in one way or the other (Evans & Fitzgerald, 2006). While statistical tools often yield similar results, qualitative research tools are often dependant on the perception researcher and hence in most cases may result in differing opinions for different researches conducted on the same span and area (Evans & Cotter, 2008). While some tools used lack credible evidence to back up their conclusion, some tools offer clear and simple to understand the evidence that facilitates drawing of conclusion to given research.

Proposed theoretical approach

Most research papers argue in favor of the evidence-based practice. Evidence practice has not only emerged as an alternative to existing diagnostic methods but as a toll upon which timely and more precise diagnostics are made (Evans & Cotter, 2008). EBP is cited as not only reducing the costs incurred by patients but also saving a lot of time that would have otherwise been wasted in attempts aimed at coming with the right diagnosis and treatment method/approach (Brown, 2009). It offers theoretical model upon which nursing decisions are based on scholarly reasoned out evidence and hence limiting chances of misdiagnosis.

Conclusion

In conclusion, it is important to acknowledge that theoretical nursing models offer foundations upon which systematic approach is used in medical practice. The theoretical models facilitate timely diagnosis and more precise diagnosis in addition to ensuring that cases of the wrong diagnosis remain marginal within the nursing environs. Shannon, 2008 stresses that medical costs are often inflated as a result of wrong or untimely diagnosis of an individual’s condition. In the past persons have been treated for an ailment A only for the physicians to realize after lengthy periods of non-progress that the person is suffering from a different ailment B. evidence-based practices incorporates other methods into the process to produce of building upon evidence that could support a given diagnosis. Evidence-based practice is therefore merging as superior theoretical nursing models in the management of patient care and treatment.

References

Brown, S. J. (2009). Evidence-based nursing: The research-practice connection. Sudbury, MA: Jones and Bartlett.

Cotter, V. T. & Evans, L. K. (2008). Best practices in nursing care for hospitalized older adults. Avoiding restraints in older adults with dementia. American Journal of Nursing, 108(3):45-46.

Delmas, L. (2007). Best practice in the assessment and management of diabetic foot ulcers. Rehabilitation Nursing Journal, 31(6), p 228-34.

Elaine M. F. & Tracy, A. (2008). Fostering the scholarship of discovery and integration for advanced practice education. Nursing Education Perspectives, 4(3), p 5 -9.

Evans, D. & Fitzgerald, M. (2006).The experience of physical restraint: a systematic review of qualitative research. Contemporary Nurse. Journal for the Australian Nursing Profession, 13(2):126-135.

Evans, D., Wood, J. & Lambert, L. (2007). Patient injury and physical restraint devices: a systematic review. Journal of Advanced Nursing, 41(3):274-282.

Evans, L. K. & Cotter, V. T. (2008). Avoiding restraints in patients with dementia: understanding, prevention, and management are the keys. American Journal of Nursing, 108(3):40-49.

Garrard, J. (2007). Health sciences literature review made easy: The matrix method (2nd ed.). Sudbury, MA: Jones and Bartlett.

Glanville, I., Schrim, V., & Wineman, N. (2008). Using evidence-based practice for managing clinical outcomes in advanced practice nursing. Journal of Nursing Care Quality, 15(1), p 1-11.

Harrison, M.B. et al. (2006). Leg-ulcer care in the community, before and after implementation of an evidence-based service. Canadian Medical Association Journal, 172(11), p 1447-1452.

Healey, F. et al. (2008). Effect of bedrails on falls and injury: a systematic review of clinical studies. Age Ageing, 37(4):368-378.

Houser, J. (2008). Nursing research: Reading, using and creating evidence. Sudbury, MA: Jones and Bartlett.

Hughes R. (2008). Nursing Older People. Nursing Journal, 20(3):33-39.

Meyer, G. et al. (2009). Interventions for preventing and reducing the use of physical restraints in long-term geriatric care (Protocol). Cochrane Database of Systematic Reviews , 1(1): 12 – 17.

Osburne, R. C. et al. (2006). Improving Hyperglycemia Management in the Intensive Care Unit: Preliminary Report of a Nurse-Driven Quality Improvement Project Using a Redesigned Insulin Infusion Algorithm. The Diabetes Educator, 32(2): 394-403.

Park, M. & Tang, J. H. (2007). Evidence-based guideline changing the practice of physical restraint use in acute care. Journal of Gerontological Nursing, 33(2):9-16.

Saarnio, R, et al. (2009). The use of physical restraint in institutional care of older people in Finland: nurses’ individual, communal and alternative modes of action. Journal of Clinical Nursing, 18(1):132-140.

Shannon, R. J. (2008). A Cost-utility Evaluation of Best Practice Implementation of Leg and Foot Ulcer Care in the Ontario Community. Wound Care Canada, 5 (1), p 53-56.

Shapiro, S. E. & Donaldson, N. A. (2008). Evidence-Based Practice for Advanced Practice Emergency Nurses, Part III: Planning, Implementing, and Evaluating an Evidence-Based Small Test of Change. Advanced Emergency Nursing Journal, 30(3):222-232.

Shapiro, S. E. (2010). Grading Evidence for Practice: Looking at graded evidence before changing practice. Advanced Emergency Nursing Journal, 32(1), p 59-67.

Shapiro, S. E. Evidence-Based Practice for Advanced Practice Emergency Nurses: Using evidence as a basis for advanced practice in the ED. Advanced Emergency Nursing Journal, 29(4):331-338.

Wolff, A. M., Taylor, S. A. & McCabe, J. F. (2007). Using checklists and reminders in clinical pathways to improve hospital inpatient care. Medical Journal of Australia, 181(8), p 428 – 431.

Table 1: Matrix Table (references).

Author, Title Source Date (year) Research Type (experimental, quasi-experimental, case series, ethnographic, etc) Pop. /
sample size
Outcome measures Pertinent data from results Suggested Conclusions Comments
Engberg J, Castle, N. G. & McCaffrey, D. Physical restraint initiation in nursing homes and subsequent resident health. Gerontologist, 48(4): 442-452 2008 Experimental 50 Disapproval of physical restraint usage in dealing with patients in nursing homes A major percentage of caregivers disapprove use of physical restraint and cite that in most cases it worsens rather than remedy situations. Other viable options like dialogue should be employed.
Evans D, Wood J, Lambert L. Patient injury and physical restraint devices: a systematic review. Journal of Advanced Nursing, 41(3):274-282 2008 Case study 10 Systematic approach to patient assessment and diagnosis in case of injury is a necessity. Cases where systematic approach was applied in diagnosis produced more positive results as compared to those that were not. Patients should be subjected to systematic treatment approaches if success is to be achieved within reasonable time.
Meyer G, Möhler R, Köpke S. Interventions for preventing and reducing the use of physical restraints in long-term geriatric care (Protocol). Cochrane Database of Systematic Reviews. Issue 1. 2009 Case study 15 Evidence based practice is an important tool in coming up with quick and relevant diagnosis and hence cause of treatment. Evidence based applied cases is a viable alternative to quick patient treatment and hence limit the need for physical restraint during diagnosis period. Evidence based practice can adequately be used to reduce the need for patient physical restraint within the medical scenario.
Park M, Tang JH. Evidence-based guideline changing the practice of physical restraint use in acute care. Journal of Gerontological Nursing, 33(2):9-16. 2007 Quasi- experimental 20 Usage of evidence based guidelines in elimination of the need for physical restraint in hospitals. Most nurses/practitioners cite evidence based practice as the best alternative to use of physical restraint in patient control. Evidence based practice results into permanent solutions which are not harmful to the patients.
Wolff, A. M., Taylor, S. A. & McCabe, J. F. Using checklists and reminders in clinical pathways to improve hospital inpatient care. Medical Journal of Australia,181(8):428 – 431. 2007 Experimental 100 Checklists and reminders are useful tools patient diagnosis Checklists and reminders make it easy for practitioners to develop relevant diagnosis within a short period of time. Practitioners should adopt this technique in development of relevant diagnosis to patients within reasonable period of time.
Shannon, R. J. A Cost-utility Evaluation of Best Practice Implementation of Leg and Foot Ulcer Care in the Ontario Community. Wound Care Canada, 5 (1), p 53-56. 2008 Experimental 50 Evidence based diagnosis lowers the cost of leg and foot cancer treatment Most of the cases where evidence based practice was employed recorded a significant reduction in treatment costs as compared to those that were not. Treatment is cheaper when diagnosis takes a shorter time. Evidence based makes this possible and hence should be encouraged.
Pierce, L. L. Evidence-based practice in rehabilitation nursing. Rehabilitation Nursing Journal, 32(5), p 203-209. 2007 Case study 10 Evidence based practice resulted into high probability of right diagnosis and hence ease in rehabilitation process. Cases where evidence based practice formed the foundation for diagnosis resulted into a shorter time of rehabilitant and positive results. Evidence based practice should be applied in diagnosis and hence rehabilitation efforts of patients.
Osburne, R. C. et al. Improving Hyperglycemia Management in the Intensive Care Unit: Preliminary Report of a Nurse-Driven Quality Improvement Project Using a Redesigned Insulin Infusion Algorithm. The Diabetes Educator, 32(2): 394-403 2006 Case study 30 Hyperglycemia management is dependent on how soon diagnosis is made. Early diagnosis is a necessity. Evidence based practice allows early diagnosis. Hyperglycemiacases which are diagnosed early enough are easy to mange and also less costly. Diagnosis of hyperglycemia should adopt techniques that allow early identification.
Delmas, L. Best practice in the assessment and management of diabetic foot ulcers. Rehabilitation Nursing Journal, 31(6), p 228-34. 2007 Case study 20 Diabetic foot ulcers can be treated if diagnosed early enough. Evidence based practice allows early diagnosis. Diabetic foot ulcers diagnosed early have higher probability of getting cured early enough. Diagnosis of diabetic foot ulcer should adopt techniques that allow early identification.
Harrison, M.B. et al. Leg-ulcer care in the community, before and after implementation of an evidence-based service. Canadian Medical Association Journal, 172(11), p 1447-1452 2005 Experimental 40 After implementation of evidence based care, leg-ulcer care was enormously improved. Leg-ulcer care registered significant improvement after implementation of evidence based care as compared to before. Evidence based care should be adopted as a better alternative in management of leg-ulcer.

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